Surgery combined with antibiotics for the treatment of endogenous endophthalmitis caused by liver abscess

Abstract

Backgrounds Endogenous endophthalmitis is a serious disease caused by intraocular infection that can rapidly progress to cause blindness. This study evaluated the clinical features, surgical and antibiotics treatment strategies, and treatment outcomes in patients with endophthalmitis caused by liver abscess. Methods Between April 2014 and April 2019, the clinical data of 16 patients (19 eyes) with endophthalmitis associated with liver abscess who underwent surgery at Shengjing Hospital were retrospectively analyzed. Furthermore, we evaluated the final visual outcomes in the patients to determine the efficacy of surgery. Results Fifteen patients (18 eyes) underwent intravitreal injection followed by vitrectomy after admission. One patient (1 eye) only underwent intravitreal injection. Of the 16 patients, 3 patients (3 eyes) had recurrent intraocular inflammation and eventually underwent evisceration. Systemic antibiotics were administered for all patients based on the results of vitreous humor culture, blood culture, and antibiotic susceptibility tests. Outpatient follow-ups were performed until the patients were stable (6 months). Of the 19 eyes, 1 eye (5%) had visual acuity restored to 20/200, 6 eyes (31%) had visual acuity restored to counting fingers (CF), 2 eyes (11%) had visual acuity restored to hand motion (HM), 4 eyes (22%) showed only light perception (LP), and the remaining 6 eyes (31%) showed no light perception (NLP). Drug susceptibility tests suggested that the carbapenems exhibited significant effects in the inflammatory reaction. Conclusion Endogenous endophthalmitis caused by liver abscess is a very serious condition, and the final visual outcome is poor. Timely surgical intervention combined with antibiotic treatment is essential, and the primary disease must be treated to control disease progression at the earliest.

Hypervirulent Klebsiella pneumoniae Endogenous Endophthalmitis—A Global Emerging Disease

“…Ocular findings included chemosis, red painful eye, haze cornea, and vitreous. Decreased visual acuity at presentation of hand movement or less and hypopyon were associated with poor prognosis [ 15 , 68 , 72 , 75 , 76 , 77 ]. Patients with unilocular involvement were found to be a risk factor for evisceration, in comparison with bilateral infection, one possible explanation being the delay in presentation in cases in which only one eye was affected [ 16 ].…”

“…ESBL strains were identified in up to 10–13% of cases [ 40 , 57 , 58 , 61 ]. In a recent study on 110 patients with KPLA, with a mean follow-up period of 3.65 years, Wang et al [ 76 ] found that ESBL was encountered significantly more frequently in the patients who experienced recurrence (30.0% vs. 8.89%). This finding supports the idea that ESBL should be considered an independent risk factor for the recurrence of KPLA [ 76 ].…”

“…In a recent study on 110 patients with KPLA, with a mean follow-up period of 3.65 years, Wang et al [ 76 ] found that ESBL was encountered significantly more frequently in the patients who experienced recurrence (30.0% vs. 8.89%). This finding supports the idea that ESBL should be considered an independent risk factor for the recurrence of KPLA [ 76 ]. and in these cases, cephalosporins should be replaced with imipenem or meropenem therapy [ 21 ].…”

Endogenous Endophthalmitis—The Clinical Significance of the Primary Source of Infection

“…The organisms most frequently isolated during infection are Streptococcus species, Klebsiella pneumoniae and Escherichia coli. Occasionally, cases of other etiology are also reported [ 22 , 23 ].…”

“…The prognosis of EE in the course of liver abscess is poor. Many reported cases end in enucleation or a lack of sense of light [ 4 , 23 ]. A good visual outcome is possible only in the case of a very rapid implementation of intensive treatment.…”